Much of America’s social life has changed over the last forty years. Perhaps most dramatic, the U.S. has evolved from a nation deeply contesting race relations to one with a mixed-race, African-American president. In the wake of the 1973 Supreme Court’s Roe v. Wade decision, the Culture Wars rose to a bitter confrontation over values and, while sputtering, persists in a never-ending war against a woman’s right to chose an abortion.

Equally surprising, the moralistic, Christian right suffered a nearly complete defeat in the second front of the Culture Wars, homosexuality. Homosexuality has been normalized, with gay marriage legal in 15 states, accepted within the macho military and recognized as a personal privacy right by the Supreme Court. Not unlike the relative accepance of “black” people as part of the American mosaic, “gay” people are inceasingly, unashamedly accepted as one’s children, friends, neighbors and fellow employees.

To appreciate how this happened, one needs to recall the battle over the definition of homosexuality that has raged for the last four centuries. This new nation was founded on strict moral principles, so for righteous Puritans old-fashion sodomy was a hanging offense. As the U.S. has increasingly secularized, refashioned by a commodity-sectacle consumer market economy, medicine, as a form of “neutral” science, came to mediate the conflict over moral values.

Psychiatry, through its professional association, the APA, sets the standard of normalcy. The Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) is the official handbook of psychological deviance and, thus, normalcy. Its influnce was at its height during the decades of the Korean War. Cold War patriotism demanded a strict adherence to patriarchial masculity, an ethos that rejected – but was terrorized by! – its wilder sexual desires. The medical profession, especially psychiatry, stradled the no-man’s-land seperating religion and law enforcement.

The tumultuous ‘60s affected nearly all aspects of American life. Most pointedly, it was expressed in the social forces of the civil rights movement, antiwar activism, the counterculture and the emergent women’s movement. They came together in the fledgling gay-rights movement. One of the era’s singular expressions of rebellion was the infamous 1969 Stonewall riot in New York’s Greenwich Village. It revealed the growing militancy of a long-hidden, often closeted minority, “homosexuals,” whether dyke or fag. Their refusal to accept 2nd-class status exploded public consciousness. One consequence of the riot was that an increasing number of social institutions came under public scrutany as to their treatment of gay people. One target was psychiatry.

In the wake of Stonewall, gay activists led by Frank Kamery intensified their campaign against the questionable medical assumptions – and political consequences — that underlay psychiatry’s analysis of homosexuality. These assumptions, by extension, were applied to other sexually-identified mental disorders like fetishism and transexualism. The gay activist campaign took many forms, but — in the spirit of ‘60s activism – is most remembered by its direct interventions against this (allegedly) neutral, scientific profession, psychiatry.

Inspired by the civil rights movement’s challenge to racism, the antiwar movement’s confrontation with the military-industrial complex and the women’s movement battle against patriarchy, gay activists set their sights not only on disrupting the public presentations of a number of psychiatry’s leading spokesmen but, most importantly, redefining the APA’s DSM. While the then-current DSM-II did not use the term “perversion,” it did refer to homosexuality and other sexual deviances as mental disorders, “pathological deviation[s] of normal sexual development.”

Gay activists understood that science — like sexuality – is a social category, one that changes over time. Over the last century-and-a-half, once reputable “sciences” – as well as illicit sexual practices denounced as perversions — have been revised, leading to changes in social beliefs and values. Phrenology was once considered a science and eugenics once promised a better human species. Similarly, medical authorities once warned that masturbation was a derangement and oral sex a sin. These beliefs were once unquestionably accepted only to be, with time and critical engagement, deposited in the dustbin of history.

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Ideas matter, especially within the elite psychiatric profession. It includes many well-read, learnered men and woman. Shrinks have real power, they prescribe drugs and testify in court. They determine if someone is sane or mad, well or sick, normal or pervered. So, a formal, public debate between learned psychiatrists offered an unprecedented opportunity to engage a critical issues – what was homosexulity? It could also be a unique venue for professional intellectuals to flex their muscles.

One of the seminal intellectual debates of the 20th century took place in Honolulu (HI) on May 13, 1973. The event was masterfully organized by Robert Spitzer. In the early ‘70s, he was on the faculty of New York State Psychiatry Institute and a member of the APA’s Committee of Nomenclature. He took the lead in trying to resolve the growing challenge to psychiatry’s analysis of homosexuality. He did this through a series of what historian Ronald Bayer calls “compromises,” tactical changes in the diagnosis of homosexuality. His nomenclature compromises reveal the shifting terrain of intellectual engagment: “sexual orientation disturbance” (1973), “ego-dystonic homosexuality” (1980) and, finally, “sexual disorders not otherwise classified” (1986). “In fact,” insists Bayer, “it was Spitzer’s own conceptual struggle with the issue of homosexuality that framed the [Nomenclature] committee’s considerations.”

The momentous Hawaii symposium drew between 500 and 1,000 psychiatrists. It pitted well-recognized authorities in a rigorous exchange as to the meaning of homosexuality and its place in psychiatric analysis, medical – and legal — diagnosis. Two conservative stalwarts, Irving Bieber (New York Medical College) and Charles Socarides (Albert Einstein College of Medicine), defended the orthodox outlook. They were challenged by three psychiatrists from the University of Southern California, Richard Green, Judd Marmor and Robert Stoller. Spitzer stacked the deck by inviting Ronald Gold of the Gay Activist Alliance (GAA).

Those advocating the orthodox perspective did so partly within terms of Freud’s famous 1935 letter to an American mother concerned about her son’s homosexuality:

… May I question you, why do you avoid it? Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. … It is a great injustice to persecute homosexuality as a crime, and cruelty too. [Freud, 1935, pp. 606-07]

Both Bieber and Socarides went out of their way to separate themselves from those who persecuted homosexuals, thus directly repudiating charges that they were homophobic or opposed civil rights for gays.

For them and others opposed to the de-classification of homosexuality as a disorder, everything hinged on it being understood, in Freud’s words, as a “sexual function produced by a certain arrest of sexual development.” Arrested development, for Bieber and Socarides, is rooted in a young male’s maladaptation (they say nothing about females) to a dysfunctional heterosexual family. Their analyses are quite specific:

Bieber: … [T]he dislocations in heterosexual organization of biologically normal children occur as a consequence of pathological family formation. … [H]omosexuality is not an adaptation of choice; it is brought about by fears that inhibit satisfactory heterosexual functioning. … I suggest that homosexuality be characterized as a type of sexual inadequacy since most homosexuals (especially those who are exclusively homosexual) cannot function heterosexually.

Socarides: … [H]omosexuality represents a disorder of sexual development and does not fall within the range of normal sexual development. … [A] pathological parent-child relationship [is] in the background of all the homosexual studies … . The frequency of a parental combination consisting of a close-binding, overintimate mother and a hostile, detached father statistically differentiated the homosexuals from the heterosexual group ….

Bieber and Socarides held firm to the orthodox psychoanalytic paradigm.

The others who rejoined Bieber and Socarides on the dais that day challenged many of their – and psychoanalysis’s — underlying assumptions:

Green: Using statistical deviances per se as a diagnostic basis evokes problems. Geniuses are deviant. So are the left-handed, vegetarians, pacifists, the celibate, and the esoterically religious. … The classification I am proposing here would include the heterosexual or the homosexual who finds it difficult to maintain desired object relationships, who compulsively uses sexuality to ward of anxiety or depression, or whose sexuality typically leads to depression or anxiety.

Marmor: All personality idiosyncrasies are the result of background developmental differences, and all have specific historical antecedents. … [W]e do not have the right to label behavior that is deviant from the currently favored by the majority as evidence per se of psychopathology. … Thus, from an objective biological viewpoint there is nothing ‘‘unnatural’’ about homosexual object choice.

Stoller: … [H]omosexuality is not a diagnosis. … There is homosexual behavior; it is varied. There is no such thing as homosexuality. … So I see perversions (but not all sexual deviations and not all homosexual behaviors) are modifications one must invent in order to preserve some of one’s heterosexuality.

Finally, Gold was unflinching in his criticism of the then-current APA classification of homosexuality:

I have come to an unshakable conclusion: the illness theory of homosexuality is a pack of lies, concocted out of the myths of a patriarchal society for a political purpose. Psychiatry – dedicated to making sick people well – has been the cornerstone of a system of oppression that makes gay people sick. … Take the damning label of sickness away from us. Take us out of your nomenclature.

As Spitzer recalled, the symposium resulted in two important APA decisions. First, the Board approved removal of the term homosexuality from its category of mental disorders; second, it passed a resolution calling for equal civil rights for homosexuals. “[Homosexuals] were suffering,” Spitzer acknowledged, “they could not achieve civil rights in America as long as psychiatry looked at them as a disorder.”

The APA’s decision to remove homosexuality from its list of mental disorders contributed to the redefinition of sexual perversion. The decision led to similar resolutions by other organizations, including religious groups like the Society of Friends, Lutheran Church and National Council of Churches as well as the American Bar Association, the AMA and the American Psychological Association. Cities across the country passed laws explicitly prohibiting discrimination based on sexual orientation. Perhaps most important, the decision led to the removal of sodomy laws in more than a dozen states.

When the battle started, Spitzer, and most other psychiatrists, understood homosexuality as “a pervasive disorder of personality.” By the time the DSM-III-R was adopted in 1987 (amidst of the AIDS crisis), homosexuality had lost its negative connotation and — only if accompanied by serious distress — was formally reclassified as a “sexual disorder not otherwise classified.” And what went for homosexuality applied equally to other, previously identified perversions.

The APA decision undercut the then, all-inclusive legal notion of “moral turpitude.” Once upon a time one could be arrested for engaging in practices, sexual and otherwise, that were contrary to “community standards.” In the DSM-III, the APA introduced a new notion of hitherto-unacceptable sexual practices, “paraphelia.” As Spitzer acknowledged, the reason the Nomenclature Committee adopted the term “paraphelia” for the DSM-III was that “nobody knew what it meant.”

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A century ago, American women wore ankle-length dresses with corsets, masturbation was decried, intercourse was for procreation not pleasure, abortion a crime, contraceptives banned, interracial sex a hanging offense, pre-marital sex forbidden, pornography an obscenity and homosexuality a sin. Today, that world is over.

Four short decades ago, the APA’s 1973 Hawaii debate over homosexuality challenged – both intellectually and politically – accepted moral values. Would a distinct minority, those with homoerotic inclinations, continue to be persecuted while another minority – African-Americans – were accepted as part of American society?

The die was cast, a new political vocabulary was finding its voice. Homosexuality was being recast, redefined as a minority not less human – or threatening – then African-Americans, Hispanics, Asians or the disabled. The once racists, Puritan nation was being recast. The 20th century was being defined, sexually and otherwise. And with it the 21st century.